Infectious Complications of Extended Peripheral Intravenous Catheters (EPIVs) in a NICU
Central line-associated bloodstream infections (CLABSIs) are important causes of morbidity and mortality in neonatal intensive care unit (NICU) patients. Extended peripheral intravenous catheters (EPIVs) are increasingly used as an alternative to central venous catheterization in some NICUs, but data about infectious complications are lacking. The frequency of infectious complications of EPIVs in 101-bed Level IV NICU utilizing these catheters since 11/2011 is described.
All BSIs were prospectively identified in neonates cared for in a NICU between January and December 2013. CLABSIs were designated according to NHSN definitions. Infections that would have met the NHSN CLABSI definition but had an EPIV in place rather than a CL were classified as EPIV-associated blood stream infections (EPIV-aBSIs).
Between January 1 and December 31, 2013, there were 227 EPIV insertions. Bacteremia developed in 3 infants with EPIVs (E. coli = 2, methicillin-resistant S. aureus (MRSA) =1). The EPIV-aBSI rate was 1.8/1000 catheter days, compared to the CLABSI rate of 1.04/1000 device days (total infections=7). Two infants developed local infectious complications (abscess or necrosis at line site).
EPIVs were associated with appreciable infectious morbidity in this NICU. The EPIV-aBSI rate was higher than the CLABSI rate. Standardized, evidence-based protocols for the insertion and maintenance of EPIVs are needed. Reporting only CLABSI rates in the NICU underestimates the burden of bacteremia associated with intravenous catheterization.
L. Boland, None
J. Behr, None
L. Morris, None
S. Duncan, None
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